Case contributed by Dr Nikola Todorovic


The patient is febrile and he has a productive cough for the last couple of days.

Patient Data

Age: 70
Gender: Male

There is a reduced transparency of the lung parenchyma paracardial on the right with an area of patchy and reticular opacifications. The right border of the heart is not obscured, so the process is most probably placed in the right lower lobe.

Besides that, there are signs of unhealed right clavicle fracture, fractures of the first three ribs on the right, dislocation of the left sternoclavicular joint and serial rib fractures on the left.

The heart is enlarged and has an aortic configuration.

Case Discussion

The patient was sent by his GP for a chest radiography because of the listed symptoms and also a leukocytosis.

Lung parenchymal changes are in the so-called Dittmar-Rupert triangle which is defined as a space bordered by a hemidiaphragm, heart and the imaginary line that connects the center of the hilum and ipsilateral costophrenic sinus.

He is advised to repeat his chest radiography in four-six weeks, after antibiotic therapy.

He has a history of the fall on the right side, from three meters height two months ago and also even older trauma due to fall on the left side. A radiograph after that fall is almost the same as this one except for the lung parenchymal pathology.

After the fall he visited an orthopedic surgeon who decided to apply a conservative therapy, which unfortunately gave no improvement, so he is advised to visit him again.


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Case information

rID: 53012
Published: 1st May 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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